Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx xxx xxx Provision xx Xxxxxxxxx Support to Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx to Xxx Xx. 209/1997 Xxxx., on the xxxxxxxxx xx fulancial xxxxxxx xx xxx xxxxxxx xx xxxxxxxx xxxx xxx on xxxxxxxx certain xxxxx xxxx, as xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx with xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, filling xx xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx the xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx support xxxxxxxx xx Act no. 209/1997. Xxxxx xxx xxx your xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

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X. Xxxxxx legibly xxxx xx xxx xxxxxxxx data xx xxx xxxxxxxxx - x.x. the xxxxxx xx xxx xxxxxxxx xxx xxx xxx xxxxxxxx bodily harm, xx xxx xxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxx act:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxx xx birth:

4. Xxxxxxxxx xxxxxxx:

5. Mail xxxxxxxx xxxxxxx (xxxxxx xx xxxxxx xxxx xxx permanent address, xxxx):

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx xxxxxxxxxxx by xxxxxxx xxxxxx ("representative") xx xxx xxxxx xx xxxxxxxxx representation (xxx instance, x xxxxx child represented xx xxx/xxx xxxxxx) xx xx xxx xxxxx xx a xxxxx xx xxxxxxxx, xxxxxx xxxx in xxx data of xxxx representative:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx is xxxxxx xxx xxxxxxxxxxx xx xxxxxx xx xxx applicant, please xxxx submit a xxxxxxxx xxxxxxxxxxx xxx/xxx xx represent xxx xxxxxxxxx - x xxxx of x xxxxx xx xxxxxxxx (xxx contractual representation) xx x xxxx xx xxx xxxxx xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) or xxx xxxxx xxxxxxxxxx document.

III. Xx xxx applicant xx a xxxxxxxx xx x xxxxxx xxx has died xx consequenee xx xxx respective xxxxxxxx xxx, xxxxxx xxxx xx xxx personal xxxx xx xxx xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxx xx xxxxx:

5. Last permanent xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxxxxx (x.x. xxxxxx, daughter, xx xxxxxxxxxx living xx xxxxxx xxxxxxxxx)

Xx xxx xxxxxxxxx xx x survivor of x person xxx xxxx in xxxxxxxxxxx xx the criminal xxx, xxxxxx xxxxxx x xxxx xx xxx xxxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx supported xx xxx an xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (in xxx xxxx xx a xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx or a xxxxx decision xx xxx xxxxxxxxxx xx xxxxxxx the xxxxxxxxx; xx xxx xxxx xx married xxxxxxx, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxxx).

Xxxxxx specify xxx xxxx on which xxx xxxxx was xxxxxxxxx and, xx xxx victim xxxxxxx xxxxx xxx xxxxxxxxxxxx xx xxx crime xx x xxxxx xxxx, please also xxxxxxx xxx date xxx xxx xxxxxx xx xxxxx xxx xxxxxx learned of xxxx xxxxxxxxxxxx (e.g., xxx date xx xxx medical xxxxxx).

XX. Xxxxxx xxxxxxx xxx xxxxxxxx justice xxxxxxxxx (x.x. police, xxxxxx xxxxxxxxxx'x xxxxxx, court) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx reference xxxxxx xx xxx xxxx related xx xxx xxxxxxxxxx proceedings.

If xxxxxxxxx, please xxxxxx xxx xxxxxx xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx justice xxxxxxxxx xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx respective xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx xx xxxxxxxx prosecution, xxxx xx the xxxxxxxxxx, xxxxxxxxx - xxxxx xx otherwise).

According xx xxx provisions xx §8 of Xxx xx. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx xx xxxxxxx xxx xxxxxx xxx xxxx use xx xxx legal xxxxxxxx xx xxxxxxx x xxxxx xxx xxxxxxxxxxxx xxxxxxx the xxxxxxxx xx xxx xxxxx xxxxxx responsible xxx xxx harm xxxxxxxx. Do xxx xxxx xx this xxxx xx xxx xxxxxxxx has xxx xxxx xxxxxxxxxx.

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Xxxx in xxxx XxXx xx xxx xxxxxxxxx xx x xxxxxxxx of xx individual xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

1. Xxx xxx x xxxxx, xxxxxx or xxxxx xx the xxxxxx xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxx xxxxxxx?

2. Xxx you xxxx xx a xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx xxxxxx xxxxx xx the xxxxxxxxxx xx the xxxxx?

3. Xxxx xxx x xxxxxxxxx of xxx xxxxxx xx xxx xxx deceased xxxxxxx xx xxxxxxx xxx?

4. Xx xxx xxxxx xxxxxxx meet xxx xxxxxxxxxx xxxxxxxxx in xxxxxxx 1 xx 3? Please xxxx xxxxx xxxxxx, if xxxxx xx xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 xx Xxx xx. 209/1997, a xxxxxx xxx is x survivor xx x xxxxxx who xxxx xx xxxxxxxxxxx xx a criminal xxx is considered xx xx x xxxxxx xx xx xx she is x parent, xxxxxx xx xxxxx xx xxx deceased xxx xxxxx with him xx xxx xx xxx same xxxxxxxxx xx xx xxx xxxxxx xxx x xxxxxxxxx xx the xxxxxxxx or xxx xxxxxxxx xxx xxxxxxxx xx support xxx xxxxxx.

Xx the xxxxxxxxx xx the victim xx x xxxxx xxx xxx suffered xxxxxx xxxx, xxxxxx xxxx xx items XX - XIV.

Xxxxxx xxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxxx xxx xxxxxxxxx xxxxxxxx to Xxxxxx Xx. 440/2001 Xxxx. The respective xxxxxxxx xxxxxx xx xxxxxxxx xxxx xxx xxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx a xxxxx-xxxxx assessment of xxx xxx xxxxxxxx xxx x point-based xxxxxxxxxx xx xxx xxxxxxxx of xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx bear xx xxxx that xxxx xxx point-based xxxxxxxxxx xx the xxx xxxxxxxx xx relevant xxx xxx xxxxxxxx xx Xxx no. 209/1997. Xxxxxxxxx xx xxx xxxxxxxxxx of §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx xxxxxxxxx xxxxxxx will be xxxxxxxx unless the xxxxx assessment xx xxx pain suffered xx xx xxxxx 100 xxxxxx.

Xxx xxxxxx xxx obtain xxxx xxx financial xxxxxxx xx xxx xxxxxx xx XXX 25,000 xx an xxxxxx xxxxx xx xxx proved costs xx xxxxxxx treatment xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). lf you xxxxxx xx apply xxx x xxxx xxx payment, xxxxx xx xx xxxx xx xxxx xx xxxxx XII - XxX.

Xxxx includes xxx expenses xxx xxxxxxxxxx, sanitary xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx xx xxxx out xx xxx xxxx xx xxxx xxxxxxx treatment, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., provided xxxx xxxxx xxxx xxx xxxx xxxx by xx insurance xxxxxxx. xx such xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may xxx xxxx them xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx facts xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx xx xx xxxxxxxx, xxxxx documents xxxxx xxxxxxx x xxxxxxxxx from his/her xxxxxxxx xxxxxxxxxx the xxxxxxx xxxxxx xxxxxxxxx xx §351 xx. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx amended. xx xxx xxxxxxxxx is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx xx x xxxx of xxx/xxx xxxx xxxxxx tax xxxxxx. lf the xxxxxxxxx is x xxxxxxx person xxx xx xxxx xx xxxxx xxx/xxx xxxxxxxx xxxxxx standing, xxxxxx xxxxxx a document xxxxxxxxxx xxx xxxxxx xx xxx retirement xxxxxxx. xx for xxx xxxxxx the xxxxxxxxx'x income xxxxxxxxx xxxxxx be xxxxxx, xx xxxxxxxxxxx xxxxx xx xxxxxxxxx xxx xx xxxxxxxx.

Xx xxxxxx standing xxx xxxx impaired xx x xxxxxx xx xxx xxxxxxxx xxx xx xxxxx X xxx a xxxxxx. X xxxx not xxx xxxx xxxxxxxxxxx xxx xxx harm 1 xxxx xxxxxxxx xx x xxxxxx xx xxx xxxxxxxx xxx.

X xxxxxx affirm xxxx X xxxx xxx xxxxxx xxx xxxxx for financial xxxxxxx or xxx xxxxxxx claim for xxxxxxxxxxxx for the xxxx suffered xx x xxxxxx of xxx criminal xxx xx xxx xxxxxxx xxxxx than the Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx according to §12 of Act Xx. 209/1997 Coll., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx, X xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Xxxxxxx xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx the xxxx xxxxxxxx, up xx the xxxxxx xx xxx xxxxxxxxx xxxxxxx, within xxxx xxxxx xxxx the xxxx xx xxxxxxxxx xxx funding support. X also acknowledge xxxx, xxxxx xxx xxxxx of xxx xxxx-xxxx xxxxxx, I xxx xxxx an xxxxxxxxxxx xxxxxx xxx Xxxxxxxx of Xxxxxxx xx waive xxx xxxxx'x xxxxx xxx xxx xxxxxx xx xxx xxxxxxxx support, xxxxxx xxxx x xxxxxx xx xxxx xxxxxxxx by my xxxxxx xxxxxxxx, the xxxxx xxxxxx xx xxxx xxxxxxxx and xxx amount xx xxxxxxxxxxxx xxxxxxxx.

X also xxxxxxxxxxx xxxx consciously xxxxxx false xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxxxx xx xxxxxxxxxxxxx gaining xxxxxxxx xxx xxxxxxxxx an xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., on xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx xx xxx xxxxxxxxx or xxx/xxx representative

- Upon xxxxxxx of xxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant xx Xxx Xx. 209/1997, xxx Xxxxxxxx of Xxxxxxx shall confirm xxxxxxx xxx xxxxxx xx a xxxxxx xxxxxx. Subsequently, xxx Xxxxxxxx shall xxxxxxxx xx investigation xxxx xxx xxxxxx xx x similar xxxxxxxxx xx per the xxxxxxxx xxxxxxx of xxx case. Within xxxxx xxxxxx from xxx date xx xxx receipt xx xxx xxxxxxxxxxx xxx xxxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall xxxxxx xxxxxxx xxx xxxxxxx xx xxxxxx xxx xxxxxxxxx of xxx xxxxxxx xxx such xxxxxxx has been xxxxxxxx.

- The xxxxxxxxx xxxxx xx xxxxxxxxxx x xxxxxx xx xxx Act Xx. 209/1997 Coll. xxxx xx xx/xxx xxx xxxxxxxx xxxxxx harm xx a result xx xxx xxxxxxxxxx xx x crime. X necessary xxx xxx the ohly xxxxxxxxx for xxx xxxxxx'x receipt xx xxxxxxxx xxxxxxx shall xx xxx xxxxxx xx xxx point-based xxxxxxxxxx of the xxx suffercd (xxx xxx xxxxxxxxx of xxxxxx position), which xxxx be xx xxxxx 100 xxxxxx. Xxxxxxxxx of x xxxxxx xxx xxx xxxx in consequence xx a xxxxx xxxxx be considered xx be a xxxxxx xx xxx xxxxxxxx xx a xxxxxx, xxxxxx xx xxxxx of xxx xxxxxxxx xxx the xxxxxxxx shared x xxxxxxxxx xxxx the xxxxxxxx xx the xxxx xx xxx/xxx xxxxx or xx xxx xxxxxxxx supported xx was xxxxxxxx xx support the xxxxxxxx.

- Act Xx. 209/1997 Xxxx. on xxx provision of xxxxxxxxx xxxxxxx xx xxxxxxx of xxxxxxxx xxxx stipulates a xxxxxxxxxx xxxx of 1 xxxx from xxx xxxx on xxxxx the xxxxxx xxxxxxx xx xxx xxxx xxxxxx xx xxx crime. Xx xxxx xxxx xxxx xxx xxxxxxxx with xxx xxxx of xxx commitment xx xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx of xxx xxxx xx which xx/xxx xxxxxxx of xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx for the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx anytime xxxxx the xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Financial xxxxxxx xx xxxxxxx for xx a victim xxx xxx xxxxxxxx xxxxxx xxxx as x result xx xxx commitment xx x xxxxx xxx xx in the xxxx xx a xxxx sum amounting xx CZK 25,000 xx xx amount xxxxx to xxxx xxxxxx xx xxx xxxxx xx xxxxxxx xxxxxxxxx xx xxxxxx xx xxx victim, xxxxxxx xx xxx xxxxxx previously xxxx xx the victim xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx xxxxx amount xx such support xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx the provision xx support, the xxxxxx xxxxxx that xxx harm suffered xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx xx to xxx xxxxxx xx XXX 150,000 xx xx/xxx xxxxxxx xxx xx xxxxxx the xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx xxxx xxx xxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx by the xxxxx); xx xxxx xxxx, any xxxxxxx xxxxxxx xxxx xxxx xx taken into xxxxxxx.

- Xx xxxxxxxxxx xxx xx a xxxxxxxx of x xxxxxx who has xxxx as x xxxxxx of xxx xxxxxxxxxx of x xxxxx (x xxxxxx, xxxxxx or xxxxx xx xxx xxxxxxxx xxxxxx in a xxxxxx household xxxx xxx deceased xx xxx time xx xxx/xxx death xx xxxxxxxxx xx xx xxxxxxxx xx xx xxxxxxxxx xx xxx xxxxxxxx) shall xx xxxxxxxx with x xxxx sum xxxxxxxxx xx CZK 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx not xxxxxx XXX 450,000; xxxxxx the number xx xxxxxxx exceed xxxxx, xxx xxxxxx xxxxxxxx per xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Coll. xxxx xxx xxxxxxx xxx xxxxxxxxx of xxx xxxxxxxxx liability of xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx traffic xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx xxxx xx directed xx xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx in xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx circumstances, xxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx financial xxxxxxx xx xxxxx xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Xxxxxx bear xx mind xxxx xxx xxxxxxxxx documents xxx confirmations required xxx the xxxxxxxxxx xxxxx xxxx xx xxxxxxxx to xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx fails xx xx so, the Xxxxxxxx xx Xxxxxxx xxxxxx properly process xxx xxxxxxxxxxx. Should xxx xxxxxxxxx fail xx deliver xxx xxxx documents xxx xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx fact xxx xxxxxxx a decision xx withhold xxx xxxxxxx as xxx Xxx No. 209/1997 Xxxx. Xxxx xxxxx xxx, xxxxxxx, prejudice xxx xxxxxx xx xxxxxxx application.

- Please xxxx in xxxx xxxx the xxxxxxxxx xxxxx be obliged xx xxxxxx any xxxxxxxxx amount xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx the xxxxxxxx, xxxxxxxx xxx.) xx xxx account xx xxx Xxxxxxxx xx Justice xx xx the xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx apply xx xx/xxx has xxx received xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx xx xxx xxxxxx in an xxxxxxxxxxx, xxx Ministry xx Xxxxxxx may xxxxx xxx xxxxx'x xxxxx xx xxxxx xxx return of xxx xxxxxxxxx xxxxxxx xxxxxxxx after xxx xxxxx xx xxx xxxx-xxxx xxxx, xxxxxxxx xxxx x xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x social xxxxxxxx, xxx xxxxx xxxxxx of xxx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx xxxx xx xxx xxxxxx.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, x ktorej xx xxxxxxxxxx, xxx xxxxxx Xxx obťažovať xxxxxxxxxxxx xxxxxxxx. X xxxxxx rýchleho xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx však vyplnenie xxxxx dotazníku nevyhnutné. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx xx xxxxx ceníme.

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I. Prosím, xxxxxxx xxxxxxľxx xxxxxx xxxxx x xxxxxxxľxxx - xxxxx trestného xxxx, ktorej xxôxxxxxx xxxx xx xxxxxx, xxxxx osobe pozostalej xx xxxxx, ktorá x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum xxxxxxxxx:

4. Xxxxxx trvalého pobytu:

5. Xxxxxxxxxxxxxx adresa (x xxxxxxx, xx xx xxxx od xxxxxx xxxxxxxx bydliska):

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx iná xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) xxxxx xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx xxxxx, xxxx xx doložiť xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Preto k xxxxxxxx xxxxxxxx kópiu xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx rodného xxxxx (x xxxxxxx zákonného xxxxxxxxxx) xxxxx xxx xxxxxxx listinu.

III. Ak xxxxxxxľ xxxxx osoba xxxxxxxxx po xxxxx, xxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx, xxxxxxx, xxxxxx, xx xxxxx o umretej xxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx bola zomretá xxxxx x xôxxxxxx xxxxxxxxx činu x xxxxx žiadateľa (xxxx, xxxxx, xxxxx xxxxxx x spoločnej xxxxxxxxxx):

Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx po osobe, xxxxx x dôsledku xxxxxxxxx činu xxxxxxx, x xxxxxxxx sa xxxx priložiť xxxxx xxxxxxxx xxxxx a xxxxxxx, xxxxx dokladajú xxxxxxxxxx, xx xxxxxx xxxxx xxxxxxxxxx pozostalú xxxxx xxxxx xxxx xxxxxxxxx ju xxxxxxxxx (xx xxxxxx xxxxx - xxxxx xôxxx x xxxxx list xxxxx xxxxxxxxxxx súdu x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx bude xxxxxxx xxxx x pod.)

IV. Xxxxxx, či xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx xx xxxxxxx xxxx; x xxxxx xxxxxxx láskavo xxxxxxx xxxxx Xxxxx xxxx.

X. Xxxxxx xxxxx, xxxx xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx.

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx xxxx x ak sa xxxx o xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, uveďte xxxx x ako (xxxxxxxxx x xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx činný x xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxx xxxx. Xxxxxx xx spisovú značku, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx xxxxxxx x xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx x xxx, x xxxx xxxxxx sa xxx xxxxxxxx (xxxx. uznesenie x odložení xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), pripojte ho x xxxxxxxx.

XXX. Xxxxxx, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx na xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, ktorá xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx č. 209/1997 (Xx)., xxxxxxxx xxxxx xx môže xxxxxx alebo xx xxxxxxxx s xxxxxxxxxxxxx xx xx, xx xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx nároku na xxxxxxx xxxxx od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx zodpovedá xx škodu. Tento xxx xxxxxxxxxxx, xx xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ xx xxxxxxxxxx xx osobe, xxxxx v dôsledku xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, xx xxx xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 zákona x. 209/1997 Zb., prípadne xxľxx xxôx xxľxx xxxxx xxxxxxxxx, xx xx Xxx xxxxx xxxxxxxxxxx známe.

1. Xxxx xxx rodičom, manželom xxxxx dieťaťom xxxxx, xxxxx xxxxxxx x xôxxxxxx xxxxxxxxx xxxx?

2. Xxxx ste x xxxxxx xxxxxxxxx xxxx xxxx xxxxxxxxx trestného xxxx v spoločnej xxxxxxxxxx?

3. Poskytovala Xxx xxxx xxxxxxxxx xxxx xxxxxx, xx bola x tomu xxxxxxx?

4. Xxľxxxx další xxxxx xxxxxxxxxxx xxxxxxxxx 1 xx 3? Xxxxxx xxx xxxxx, ak Xxx xx xxxxx.

Xxxľx xxxxxxxxxxx §2 xxxx. 2 xxxxxx č. 209/1997 Zb. xx xx xxxx xxxxxxxx xxxxx pozostalá xx xxxxx, ktorá x xôxxxxxx xxxxxxxxx činu xxxxxxx, ak xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx a xxxxxxx x xxxx xxxx smrti s xxx xxxx x xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx výživu.

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Body XX. xx XIV. Vyplňte, xx xx xxxxxxxľ xxxx obeťou xxxxxxxxx xxxx x bola xx xxôxxxxxx xxxx xx xxxxxx.

XX. Xxxxxx xxxxx, kedy xx xxxxxxxx liečenie, respektíve xxxx xx xxxxxxxx xxxxxxxx xxxxxxxxxxx.

X. Xxxxxxx xxxxx bodového xxxxxxxxxxx xx xxxxxx činí:

K xxxxxxxx xx xxxx xxxxxxxx bodové ohodnotenie xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx xx xxxxxx, ktorý xx xxxxxxxxx. Xxxxx lekársky xxxxxxx bude xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx sťaženia xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx účely xxxxxx č. 209/1997 Zb. je xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 zákona x. 209/1997 Zb. nemožno xxxxxxxxx' peňažnú pomoc, xx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 bodov.

XI. Xxxxxx, či žiadate x xxxxxxxxxxx peňažnej xxxxxx xx xxxxx xxxxxxxxx xxxxxxx 25&xxxx;000.- Xx xxxxx xx xxxxxxxx výšku xxxxxx xxxxxxx x xxxxxxxx xx xxxxxxxx.

Xxxľx ustanovenia §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx xxxxxxx xxxxx xxxxx xxxxxxxxx peňažnú xxxxx vo výške xxxxxxxxx xxxx 25&xxxx;000.- Xx, xxxxx xx xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx na liečenie x xxxxxx xxxxxxx. Xx xx rozhodnete xxxxxx x xxxxxxx xxxxx xx xxxxx xxxxxxxxx čiastky, nemusíte xx xxxxxxxxx body XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Náklady xxxxxxx x xxxxxxxx xxxxxx:

Xxx o xxxxxxx xx lieky, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx na pomoc x domácnosti xx xxxxxxxxxx, xxxxxxx náklady xx xxxxxxx, x xxx. xxx xxxxxxxxxx, xx xxxxx náklady xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx mócť xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx xxxxxx žiadateľa xxxx x xx xxxxxx ujmy na xxxxxx xxôxxxxxxx trestným xxxxx.

X žiadosti xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx xxxxxxxľ je x xxxxxxxxxxxxxx xxxxxx, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx xxxľx §351 x nasl. zákona x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx je žiadateľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, takou listinou xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx dokázať xxxxxxxx xxxxxxxx situáciu, xxxx xxxxxxxxxx x xxxxx xxxxxxxxxx xôxxxxxx. X xxxxxxx, xx x nejakého xxxxxxxxx xôxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x krajnom xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Uveďte xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx xxx xxxxxxxľ poberá, xx xxxxxxx po vzniku xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx činom.

K xxxxxxxx priložte xxxxxxxxxx xxxxxxxxxxxxľx alebo xxxxxxxxx x výške nemocenských xxxxx. V xxxxxxx, xx v xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx xxxxxxxx xxxxx Xxx priznali xxxxxxxxx xôxxxxxx, xxxxxx a xxxxxxx xxxx xxxxx.

Xxxx majetkové xxxxxx xx xxxx, xx xxxxxxxx činom, xxxxxxx xxx bol(a) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxxxxxx. Škodu, xxxxx mi xxxxx xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, že xxxxx xx peňažnú xxxxx xx xxxxxxx xxxxx xx odškodnenie xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx ako v Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx vedomie, xx xx xxxľx ust. §12 zákona x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti x x zmene x x xxxxxxxx xxxxxxxxxx zákonov, v xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx odo xxx, xxx xx xxxxxxxx xxxxx, odviesť xx xxxx Ministerstva xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx xxxxxx(x) xxx xxxxxxx škody, x xx xx do xxxxx xxxxxxxxxxx pomoci. Xxxxxxx x xxx xxxxxx na vedomie, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x xxxx xxxxx xxxxxx xxxxx na xxxxxxxx poskytnutej xxxxxx, xx xxxx sociálna xxxxxxxx bude xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx spôsobili a xxxxx náhrady, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx vedomie, že xxxxxxxxx xxxxxxxx nesprávneho xxxxx xxxxxxxxx údaja xx xxxx xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx výhody, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 odst. 1 písm. c) xxxxxx x. 200/1990 Xx., o xxxxxxxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx spravodlivosti Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx poradové xxxxx. Xxxxx xxxx xxxxxxxxxx xx xxxxxxx xx na xxxx xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx troch xxxxxxxx xx xxxxxx xxxxxxxx x xxxxxxxxxx potrebných xxxxxxxx buď pomoc xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx xx xxxx xxx x xxxxxxx, xx xx v xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx priznanie xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx bodového xxxxxxxxxxx bolesti (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho aspoň 100 bodov. Za xxxx xx považuje xx xxxxx xxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx xxxxxxxx zomretého x zároveň v xxxx jeho xxxxx x ním xxxx x xxxxxxxxxx, xxxxx xxxxx, ktorej xxxxxxx xxxxxxxxxx alebo bol xxxxxxx xxxxxxxxxx výživu.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx pomoci xxxxxxx trestnej činnosti xxxxxxxxx xxxxxxxxxxx (prepadnú) xxxx 1 xxxx xxx xxx, xxx xx xxxx dozvedela x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx xxxx už xxx xx xxx xxxxxxxxx xxxxxxxxx činu, xxxx xxxxxxxx okamžik, xxxx xx to xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxxx xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, xxxxx mu xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Pomoc xx na xxxxxxx xxxxx, xxxxxx x xôxxxxxx trestného xxxx xxxxxxx škoda na xxxxxx, xxxxxxxx v xxxxxxxxx xxxx 25 000.- Xx xxxxx xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx s xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx x xxxxxx xxxxxxx xxxxx xx xxxxxxx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx obeť - po xxx, xxx xxx xxxxxxxx xxxxx - preukáže, xx xxx vzniknutá xxxxx xx xxxxxx xxx xx, xxxxx xxxx xxxxxxxxx na xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx x xxxxxx stanovenej xxxxx xxxxxxx jej xxxxx xxxxxxxxx xxxxx xxäx, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Xx; pričom xx xxxxxxxxxx na xxxxxxx, xxxxx už xxxx vyplatené.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx po obeti, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx (xx bola rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx a xxxxxxx x xxxx jeho xxxxx x ním xxxx x domácnosti, xxxxx xxx xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx xxxxxxxxxx výživu), xx xxxxxxxx peňažná xxxxx x paušálnej xxxx 150&xxxx;000.- Xx; xxxxx xx svojom xxxxx xxxxxx xxxxxxxxxx xxxx 450&xxxx;000.- Xx, x xx je xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx xx xxx xxxxxx xxxxx xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx vykonávateľa xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx je potrebné x záležitostiach xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx plnenia. Xxx x xxxxxx ojedinelých xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx xxxxxxxxx xxxxxxxxx xx možné xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx pri xxxxxxxxxxxx položkách. Ak xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx žiadosť. Ak xxxxxx xxxxxxxxxx a xxxxxxx ani dodatočne xxxxxx, táto skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx však xxxxxxxxxx xxxxxxx podať novú xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx žiadateľovi xxxxxxxxxx peňažná xxxxx, xxxxxxxľ xx do xxxxxxx xxxxx odo xxx xxxxxxxxxxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx dostal xxx xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx a xxx.) xx do xxxxx xxxxxxxxxxx pomoci. Xxxx xxxxxxxxx nemá, xx xx xxxxx xxxxxxxxxx. Na základe xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx xxxxx xx xxxxxxxx stanovenej xäxxxxxxx xxxx xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx peňažnej pomoci. Xx xxxxxx xxxxxx xxôxxxxxxx xxxxxxxx situácia xxxxx, celková xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, xxxxx obeť xxxxxxx.